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Osteopathic manipulative treatment for nonspecific low back pain: a systematic review and meta-analysis
Open accessAbstract
BACKGROUND: Nonspecific back pain is common, disabling, and costly. Therefore, we assessed effectiveness of osteopathic manipulative treatment (OMT) in the management of nonspecific low back pain (LBP) regarding pain and functional status. METHODS: A systematic literature search unrestricted by language was performed in October 2013 in electronic and ongoing trials databases. Searches of reference lists and personal communications identified additional studies. Only randomized clinical trials were included; specific back pain or single treatment techniques studies were excluded. Outcomes were pain and functional status. Studies were independently reviewed using a standardized form. The mean difference (MD) or standard mean difference (SMD) with 95% confidence intervals (CIs) and overall effect size were calculated at 3 months posttreatment. GRADE was used to assess quality of evidence. RESULTS: We identified 307 studies. Thirty-one were evaluated and 16 excluded. Of the 15 studies reviewed, 10 investigated effectiveness of OMT for nonspecific LBP, 3 effect of OMT for LBP in pregnant women, and 2 effect of OMT for LBP in postpartum women. Twelve had a low risk of bias. Moderate-quality evidence suggested OMT had a significant effect on pain relief (MD, -12.91; 95% CI, -20.00 to -5.82) and functional status (SMD, -0.36; 95% CI, -0.58 to -0.14) in acute and chronic nonspecific LBP. In chronic nonspecific LBP, moderate-quality evidence suggested a significant difference in favour of OMT regarding pain (MD, -14.93; 95% CI, -25.18 to -4.68) and functional status (SMD, -0.32; 95% CI, -0.58 to -0.07). For nonspecific LBP in pregnancy, low-quality evidence suggested a significant difference in favour of OMT for pain (MD, -23.01; 95% CI, -44.13 to -1.88) and functional status (SMD, -0.80; 95% CI, -1.36 to -0.23), whereas moderate-quality evidence suggested a significant difference in favour of OMT for pain (MD, -41.85; 95% CI, -49.43 to -34.27) and functional status (SMD, -1.78; 95% CI, -2.21 to -1.35) in nonspecific LBP postpartum. CONCLUSION: Clinically relevant effects of OMT were found for reducing pain and improving functional status in patients with acute and chronic nonspecific LBP and for LBP in pregnant and postpartum women at 3 months posttreatment. However, larger, high-quality randomized controlled trials with robust comparison groups are recommended.
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“Finally, domain 15 (publication bias assessment) was rated as not applicable for all the SRs due to lack of a meta-analysis24 30–32 or the inclusion in the meta-analysis of fewer than 10 trials.25–29”
From Efficacy and safety of osteopathic manipulative treatment: an overview of systematic reviews (2022) · cites this paper as [25]
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Experimental — accuracy not yet measuredThe source backs part of the claim, not all of it — or backs it for a different population, condition or comparison.
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“Four reviews24–27 with 34 RCTs (41 comparators) and 3369 participants assessed the efficacy of OMT on LBP, including acute LBP, chronic LBP (CLBP), LBP with sciatica, CLBP with menopause symptoms, LBP in obese patients, acute non-specific LBP (ANSLBP), chronic non-specific LBP (CNSLBP) and/or LBP and pelvic girdle pain in pregnancy and postpartum (PP). Taking into account overlapping, there were 2”
From Efficacy and safety of osteopathic manipulative treatment: an overview of systematic reviews (2022) · cites this paper as [25]
Experimental — accuracy not yet measuredThe source backs part of the claim, not all of it — or backs it for a different population, condition or comparison.
In the citing paper
“The GRADE performed by the authors revealed both a moderate quality of evidence for pain and a high quality of evidence for functional status.”
From Efficacy and safety of osteopathic manipulative treatment: an overview of systematic reviews (2022) · cites this paper as [25]
Experimental — accuracy not yet measuredThe source backs part of the claim, not all of it — or backs it for a different population, condition or comparison.
In the citing paper
“The methodological quality of all RCTs, evaluated by the authors using the RoB from the CBRG,18 reported a low and a high RoB for 13 and 2 RCTs, respectively.”
From Efficacy and safety of osteopathic manipulative treatment: an overview of systematic reviews (2022) · cites this paper as [25]
Experimental — accuracy not yet measuredThe source backs part of the claim, not all of it — or backs it for a different population, condition or comparison.
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“Similar meta-analysis results (effect and heterogeneity) have also been found in a subanalysis evaluating the effectiveness of OMT in CNSLBP patients (six trials, 771 participants).”
From Efficacy and safety of osteopathic manipulative treatment: an overview of systematic reviews (2022) · cites this paper as [25]
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“The OTLE for the outcomes of each condition was assessed to be yellow.”
From Efficacy and safety of osteopathic manipulative treatment: an overview of systematic reviews (2022) · cites this paper as [25]
Experimental — accuracy not yet measuredThe source backs part of the claim, not all of it — or backs it for a different population, condition or comparison.
In the citing paper
“Considerable (pain) and substantial (functional status) heterogeneity were found.”
From Efficacy and safety of osteopathic manipulative treatment: an overview of systematic reviews (2022) · cites this paper as [25]
Experimental — accuracy not yet measuredThe source backs part of the claim, not all of it — or backs it for a different population, condition or comparison.
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“Adverse events were evaluated in only 4 out of the 15 primary studies. Two RCTs reported minor adverse events such as stiffness and tiredness, one no adverse event and the last one evidenced adverse events not related to the treatment intervention.”
From Efficacy and safety of osteopathic manipulative treatment: an overview of systematic reviews (2022) · cites this paper as [25]
Experimental — accuracy not yet measuredThe source backs part of the claim, not all of it — or backs it for a different population, condition or comparison.
In the citing paper
“Two RCTs with 119 participants evaluated the effectiveness of OMT for NSLBP in PP women. A large effect of OMT in reducing pain and improving functional status was identified. No heterogeneity was found. However, a moderate quality of evidence for both outcomes was revealed.”
From Efficacy and safety of osteopathic manipulative treatment: an overview of systematic reviews (2022) · cites this paper as [25]
Experimental — accuracy not yet measuredThe source backs part of the claim, not all of it — or backs it for a different population, condition or comparison.
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“Moreover, considerable (pain) and moderate (functional status) heterogeneities were found.”
From Efficacy and safety of osteopathic manipulative treatment: an overview of systematic reviews (2022) · cites this paper as [25]
Experimental — accuracy not yet measuredThe source backs part of the claim, not all of it — or backs it for a different population, condition or comparison.
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“In our overview, we found that seven SRs25–28 30–32 evaluated adverse events, and from these SRs, it emerges that no severe incident involving musculoskeletal, neurological, visceral or paediatric disorders occurred after OMT.”
From Efficacy and safety of osteopathic manipulative treatment: an overview of systematic reviews (2022) · cites this paper as [25]
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“GRADE evaluation by the authors reported a low quality of evidence for both outcomes.”
From Efficacy and safety of osteopathic manipulative treatment: an overview of systematic reviews (2022) · cites this paper as [25]
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“The meta-analysis revealed a medium and small effect in reducing pain and improving functional status, respectively, and a moderate quality of evidence (downgraded due to inconsistency).”
From Efficacy and safety of osteopathic manipulative treatment: an overview of systematic reviews (2022) · cites this paper as [25]
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“Three trials (four comparators) with 242 participants evaluated the effectiveness of OMT versus obstetric care, sham ultrasound and untreated, for NSLBP in pregnant women. A large and a medium effects in reducing pain and improving functional status, respectively, were identified.”
From Efficacy and safety of osteopathic manipulative treatment: an overview of systematic reviews (2022) · cites this paper as [25]
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“Eight SRs performed an appropriate literature search,25–32”
From Efficacy and safety of osteopathic manipulative treatment: an overview of systematic reviews (2022) · cites this paper as [25]
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“All SRs24–32 evaluated the RoB of the included studies”
From Efficacy and safety of osteopathic manipulative treatment: an overview of systematic reviews (2022) · cites this paper as [25]
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“five SRs reported justification for the exclusion of primary studies.25 26 28 31 32”
From Efficacy and safety of osteopathic manipulative treatment: an overview of systematic reviews (2022) · cites this paper as [25]
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“Eight SRs25–32 accounted for the RoB when interpreting and discussing the results of the SR.”
From Efficacy and safety of osteopathic manipulative treatment: an overview of systematic reviews (2022) · cites this paper as [25]
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“five SRs25–29 carried out a meta-analysis and used appropriate methods for the statistical combination of findings.”
From Efficacy and safety of osteopathic manipulative treatment: an overview of systematic reviews (2022) · cites this paper as [25]
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“According to the critical domain established in Shea et al,12 seven25–29 31 32 and two SRs 24 30 were rated as low and critically low quality, respectively.”
From Efficacy and safety of osteopathic manipulative treatment: an overview of systematic reviews (2022) · cites this paper as [25]
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Metadata
- Authors
- Franke, H., Franke, J.-D., & Fryer, G.
- Affiliations
- University of Siegen (DE)
- Victoria University (AU)
- Corresponding author
- Fryer, Gary
- Venue
- BMC Musculoskeletal Disorders
- Published
- 2014-08-30
- Volume
- 15
- Issue
- 1
- Pages
- 286-286
- ISSN
- 1471-2474 (ISSN-L)
- PMC
- PMC4159549
- OpenAlex
- W2100515050
- Cited by
- 261
- References
- 65
- Citations by year
- 2026: 20 · 2025: 26 · 2024: 30 · 2023: 17 · 2022: 20 · 2021: 33 · 2020: 33 · 2019: 19 · 2018: 22 · 2017: 19 · 2016: 14 · 2015: 8
- FWCI
- 1.75
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- BMC Musculoskeletal Disorders (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- Victoria University Research Repository (Victoria University) (submittedVersion, cc-by)
- Funders
- A.T. Still University
- Topics
- Health Sciences › Health Professions › Physical Therapy, Sports Therapy and Rehabilitation › Musculoskeletal pain and rehabilitation
- Health Sciences › Medicine › Obstetrics and Gynecology › Pregnancy-related medical research
- Health Sciences › Health Professions › Physical Therapy, Sports Therapy and Rehabilitation › Myofascial pain diagnosis and treatment
- Keywords
- osteopathic manipulative treatment, non-specific low back pain, analgesia, functional status, chronic low back pain, acute low back pain, pregnancy, postpartum women, manual therapy, quality of evidence, GRADE assessment, risk of bias, treatment effect heterogeneity, subgroup analysis
- MeSH terms
- Female, Humans, Postnatal Care, Pregnancy, Randomized Controlled Trials as Topic, Treatment Outcome, Low Back Pain, Manipulation, Osteopathic
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